Four Month Update ACDF Surgery

Today I met with my surgeon to review the latest x-rays. I’m happy, and relieved, to report that I am pretty much healed. Two of the four vertebrae have fused already, and my surgeon has no concerns about the hardware. While waiting in the patient room I overheard the nurse practitioner, who had met with me just prior and performed a physical exam, say, “He looks phenomenal!” and my surgeon, quite proudly, responded, “And he’s a four level!”

X-Rays Taken December 16, 2022

My surgeon commented, “I should have used longer screws on you.” That gave me a bit of pause but he said no concerns. He has a great, dry sense of humor. I have no idea if he was kidding with me or not.

After getting home I’m feeling a sense of relief but also, I’m just tired. I’m tired for the first time in a while. I think because I overdid the exercise last night (yoga class followed by almost 2 hours of pickleball!). But also I think I’m just a bit in shock that this is all behind me. I’m back to, overall, being very healthy. My blood pressure was 121/88, which I have no doubt was slightly elevated due to the traffic getting to the surgeon’s office.

Things could still go sideways but it’s highly unlikely. With that, it’s time to get on with my life. The last couple of months have been great. I’m confident 2023 will be as well. I’ve been doing physical therapy and it has helped relieve muscle tightness in my neck and traps but I think I’ve exhausted the benefits I’ll see from it. I still have minor aches in my posterior neck muscles, particularly when laying down at night, which give me trouble sleeping for long stretches. I need to find a decent pillow. But hey, I’m not complaining. Life is good.

My next x-ray and follow-up appointment is six months from now.

Eleven Weeks Since ACDF Surgery

It’s now exactly 11 weeks and 3 days post-surgery. Time has flown by, especially the last 3 weeks.

During the week 7 post-op visit with my surgeon, he said my x-rays look absolutely perfect. Here they are, in all their glory:

Side View – September 27, 2022
Front View

I must admit that, during the week or two prior to the consult, I was in a bit of a panic, worried that my not wearing the hard collar in the house or that I got frustrated and mowed the lawn once (the grass had grown to be hideously tall). But that concern was all for naught.

So that was great news. I asked about fusion, to which he said it would be “at least 6 months” before any fusion would be visible.” I look forward to my next visit with him on December 20th. I am hoping, but not expecting, that fusion will be visible. More importantly, I am hoping that nothing goes wrong between now and then, and the new x-rays taken for that visit show no changes in the hardware.

The titanium plate and screws are there to lock everything into place and keep it there. So I shouldn’t be too concerned and, truthfully, am very confident. BUT…during that visit I had a list of questions, most of which pertained to returning to activity. Golf, jogging, pickleball, yoga, lifting weights, etc. etc. etc. To my utter shock, he reviewed the list and gave me the go-ahead to do just about all of those activities immediately. The only two caveats:

I was in shock. He left the room and a nurse came in shortly after and then started dispensing a very different set of instructions:

I explained that the doctor just told me I could ditch the collar and return to activity immediately. She said something along the lines of, “He doesn’t know! I’m the one you’ll be emailing if something goes wrong as I deal with the patients daily.” I got it – she’s uber-conservative because she doesn’t want the risk or hassle. He’s pretty non-chalant, knowing the hardware shouldn’t move. With that, I decided right then that I was going to bet on the hardware and the surgeon’s directions. Of course, I didn’t tell the nurse, I just nodded, all the while thinking about getting out of there and getting on with seeing how my neck would feel without a collar on.

With that, we were done and she reminded me to put the collar back on as we were leaving. I waited until I left the building and then quickly removed it for good. That was almost 4 weeks ago. I don’t recall, but I might have put it back on for the car ride home, but that was it.

Since then, I have resumed most activity that I want to do without issue. My neck was *very* stiff the first week post-collar. I was starting to worry but it loosened up slightly each day after the first week. I continued walking daily, but also added in cardio (elliptical machine) and then started lifting weights again (machines, not free weights). For the first 2 weeks I struggled with chest presses, as my right tricep was still noticeably weaker than my left. But it’s getting there and not nearly as weak as it was.

As for mobility….that is concerning. The worry was that I would lose ~30% of neck mobility due to the plate/fusion. I’d say that’s probably about right as of today, it may be even slightly worse. But I am confident that will improve over time because I don’t feel a physical restriction due to the hardware. It seems to be caused by very tight muscles in the back of my neck. I start physical therapy in a few days and am hoping that accelerates increased mobility.

A few days after getting that clearance I made the mistake of going to the golf course. The first few holes I knew it was a mistake. While I probably would be okay now, at that point it was just too soon. Not just strength wise but cardio. I played a 12 hole course that is relatively short but is named “Rolling Turf” for a reason – it’s a workout just walking that thing. I’m now using a push cart – my days of slinging my bag over my shoulder are over – but it didn’t help as I was just out of cardio shape at that point, so pushing that cart up and down hills was tough. I made it through but it wasn’t as enjoyable as I’d hoped, so I’ll lay off golf until next year.

This past week I took a chance and jumped on the pickleball court. It’s been good. Again, cardio was an issue the first few times, but it is getting there. I’m playing with/against the “beginner” level, which ranges from a handful of decent players to many who don’t even understand the rules and are wholly non-competitive. So it’s fun, but frustrating at times as I want to push myself.

That’s it for this post. Again – check out my YouTube channel as I did record a video after the visit with the surgeon. I’ll post here and record another video in a couple of weeks from now. I start back to work next week. Looking forward to it.

Looking back, these past eleven weeks since the surgery, and the months prior in pain and all of the fear and uncertainty, it’s been quite a year. I have been saying to myself since day 3 post-surgery that I could have gone back to work then. But I’m glad I was able to take this time off to truly recover. I was in a bad mental state. The lead-up to the surgery took its toll. I was burned out both with my work and with my personal life. My relationships with others suffered and I have some work to do in that regard for sure. One of the great things about the past few weeks, post-collar, is I was able to rekindle some relationships. I have more to go. I am so much more positive since the surgery. I didn’t realize it but I was in fact in physical decline for at least the past five years or so due to the cord compression and pain due to the pinched nerve. It wasn’t so bad that I couldn’t go about my life, but I was pretty negative and not very nice to be around a lot. I realize now that I was so focused on fitness because working out was my way of getting through the pain. The adrenaline that working out provided was my self-medication.


Six Weeks Since ACDF Surgery

So it’s been about six weeks since my four level anterior discectomy with fusion (ACDF) surgery. Recovery has gone really well. Honestly, it’s gone unbelievably well. In my last post, I said I woke up from surgery in no pain aside from some very achy shoulders and upper back. I just assumed that, within hours, the anesthesia and/or any pain meds they gave me during the surgery would wear off and I would be in a lot of pain. I was fully expecting to be on narcotics for the first few days, if not weeks. But the pain never came. Over the next few days the aching shoulders and upper back subsided, and even in the incision remained painless to me.

It took about 8 days for the swelling in my neck to go down. By the morning of day 10 the swallowing issues were pretty much gone. I am still, even now, six weeks later, in shock that the recovery was so smooth and painless.

I did notice that I would get tired, not sleepy tired but more of a slight fatigue, enough to want to just sit down, pretty quickly. But the next day after getting home from the hospital I was up and walking around the house a lot and doing chores.

Walking Daily

My goal as soon as I got home was to MOVE. Move, move, move. Nothing crazy, but sitting around all day was to be avoided. Don’t get me wrong – the majority of the last six weeks has consisted of me on my computer, or watching television. It’s been a slog. But just about every day I have gone on at least one long walk. The first week after surgery I walked around the neighborhood, which wasn’t easy as I live in a suburban township that has a lot of traffic and a lot of streets that do not have sidewalks. Eventually, I paid for a monthly membership at our local Community Center, because it has an indoor track. It’s about 1.3 miles from my house, so my daily routine consists of one long walk:

So about 5 miles total. Some days I will do up to 7 miles. I am convinced that walking has helped my recovery greatly, particularly by loosening up the shoulders and limbs.

I’ve tried to keep myself busy at home too, but it’s been difficult. I just haven’t been all that motivated to do anything productive. While at the hospital, prior to discharge, I was instructed to wear a hard collar whenever standing or moving. When sitting and sleeping, I could wear a soft collar. I was provided a “Philadelphia” collar for showering.

In reality, after the first week or two, I just wear the soft collar when in the house regardless of whether I’m up or just sitting. When I leave the house I absolutely always wore the hard collar. It’ll be great to not have to wear it when walking, which I hope the surgeon will allow when I meet with him next week. The Philadelphia collar was horrible – I found it was very uncomfortable and pressed too hard on my neck. It wasn’t painful, it was just awkward and I honestly don’t think was sized correctly for me. After the 2nd week, when I noticed my neck felt pretty strong, I stopped using it. I haven’t worn a collar when showering since.

My neck feels pretty strong now and has for the last few weeks. It never felt “weak” really, but I notice a difference each week since surgery. But I can tell for sure that, once I am told I can ditch the collar, that I will have some aches and there will be a transition period before I am fully comfortable without the collar. Physical therapy, which I assume will be prescribed, should help with that but just exercising and moving without the support of a collar should be enough on its own to whip my neck back into shape (no pun intended!).

Facebook and Social Media

In the weeks leading up to surgery I joined the Anterior Cervical Discectomy and Fusion Facebook group, which I highly recommend anyone going through this surgery join. But, and this is important to understand, the vast majority of discussions in that group are negative. I spotted this right away and basically turned off notifications for it until the week before my surgery, and I made sure to not even read anything negative. My main goal was to find out what I could do to make things go smoother and less painful. The vast majority of ACDF surgeries go well, people recover nicely, and they move on with their lives. If you base your perspective on what is posted to that Facebook group, you’ll expect the worst…no, you’ll expect, as I did, that at the very least you will be writhing in pain, require narcotics and muscle relaxant medications just to get through the first month if not months. Sadly, some of the advice given in that group is really bad too. The “take it easy!!!” mantra is one. Along with the insistence on telling people to drink milkshakes and eat ice cream all day, when asked what to do to ease the swelling and/or sore throat post surgery. I know it’s a bit judgmental and maybe creepy but before I consider anyone’s advice on that group I look at their profile pic. Sadly, many look like they’ve been dealing with “issues” outside of ACDF related. I won’t go any further other than to say, overall, it’s a great group to get some support and, more importantly, some useful tips for recovery. But there is a lot of sad stories going on in there for sure, and a lot of the advice given is to be avoided.

I have been vlogging my recovery on YouTube, and if you’re interested in much more detail and more timely updates on my progress, I suggest checking me out there.

Next up:

X-rays of my cervical spine are scheduled for Monday. Then, my much-anticipated follow-up appointment with my surgeon is the next morning on Tuesday. I can’t wait : ) My expectations are that I will be told that my x-rays look great, the hardware is set and that I am well on my way to fusing, and I no longer need to wear a collar. While I will be asking all kinds of questions, including when can I expect to get back to practicing yoga and lifting weights, I am expecting a “Take it easy until after PT answer.” Fingers crossed.

Surgery Success!

My Hospital Bed At Jefferson University Hospital

Wow. I just read through my last couple of posts here and almost cried. It’s been about six weeks since surgery. Honestly, I have felt pretty darn good ever since waking up from surgery. I literally was awoken by the surgical team, on the gurney on the way out of the operating room, and first things that ran through my mind were:

  1. I’m alive. I made it through.
  2. My shoulders and upper back ache, and my throat is definitely swollen, but overall I don’t have any real pain. Must be the meds or anesthesia?
  3. No radiculopathy pain in my shoulder or arm anymore!

They wheeled me to the PACU. I forget what PACU stands for, but basically it is the post surgery area where you get closely monitored until your room is available. I remember just laying there oddly elated. Elated that I got through it. Probably more so that I felt pretty good considering I had just had my neck sliced open, bones drilled, etc. etc. Really, aside from very achy shoulders I felt fine. And even the hard collar, which turned out to be a new one provided post surgery (they told me after that the collar I was issued at the surgeon’s office was WAY undersized), was not uncomfortable. I didn’t even feel any pain from the incision. It felt miraculous.

After about 2 hours in the PACU I started to get really annoyed. I recall that I kept telling myself to chill out, that you need to just be thankful. But I was annoyed that it was taking so long to get to my room. I just wanted to get to my room, see my wife, and exhale. It took almost 5 hours to get a room. The hospital was super busy. They did allow my wife to come up to see me in the PACU for a few minutes, which apparently is very unusual. Although they assured me this was an exception due to the delay in room availability, when she appeared I thought to myself, “Something must have gone wrong. They don’t let visitors in here. This might be it.” But no, I was fine. They just didn’t have rooms available.

Eventually they wheeled me to my room. I insisted on getting out of the gurney and getting into bed on my own, and they obliged. I felt like I would have no problem walking, but when I got up I was very wobbly. I was worried. My room was very small, but nice. I noticed later, during my long walks around the corridor, that my room was one of the smaller ones, and also was closest to the nurses station. That sounds like a benefit, but no, it was always noisy. But I had trouble sleeping so I liked the distraction.

Three hours later, after much begging*, an equipment tech who seemed to also double as a nursing assistant, volunteered to walk the corridors with me. I think around fifteen minutes in she started to regret it. We walked for about 25 or 30 minutes. She said it was just about one mile total. I was able to walk fine. My legs felt light. Only concern was my heart rate was up. It didn’t go down until the next day – we still don’t know why.

It wasn’t all roses. My throat was definitely swollen, big time. I did have the expected difficulty in swallowing. I forced myself to drink, through a straw of course, and eat ice chips constantly. I felt as though it was like exercise for my throat – to stretch it back out as quickly as possible. Probably not really effective approach but I figured it couldn’t hurt. The surgeon’s assistants came to check on me and when I told them about the swollen throat they immediately ordered a steroid to be injected. Within an hour or two I started to feel it working, to the point where I was able to eat dinner that evening no problem. It was actually *really* good. But when I took the cover off of the plate I got a chuckle, as it looked like steak. It turned out to be a very soft meatloaf. My complements to the culinary staff at Jefferson University Hospital – the food was excellent.

I will leave out the rest of the details as this post is getting long, but the next morning my heart rate slowed down and, since I otherwise felt good, once the surgeons saw that I could swallow they authorized discharge. Around 11am or so that morning, after one night in the hospital, I was discharged. Shockingly (to me), they let me walk out on my own. I expected a mandatory wheel chair ride, but no, the nurse told me I could go and pointed me towards the elevator. I later found out from my wife that my room was in the Ear, Nose, and Throat ward and not the neurosurgery ward, so I didn’t have nurses experienced in neurosurgery. That made some things make more sense. I won’t go into it, but the one nurse I had for the evening shift was not particularly helpful. Biggest gripe was that she wouldn’t allow me to walk. Walking, I believe, was critical to my recovery. So I was relieved when I woke up very early the next morning and met with the doctors and they told me I could be disconnected from all of the monitoring equipment and am free to walk as much as I wanted, in anticipation of discharge later that morning.

This post wasn’t meant to be a detailed trip down memory lane of my hospital stay : ) It was meant to be focused on how my recovery has gone since. But I guess it’s better to make that a separate post, so I’ll do that.

The ride home from the hospital was a little nerve-wracking but mostly uneventful. My brother and sister-in law were waiting in the drive up lane in front of the hospital. I walked out and got in and they took me home. I made it.

Surgery Tomorrow

Got the call this afternoon confirming the time to report for surgery – 4:45AM. I’m thrilled that it is early. The sooner the better.

I just recorded a couple of short videos of me standing in front of my phone and demonstrating my current neck mobility, so that I can eventually compare it. After viewing them, I was surprised to see that I currently can’t get my neck around as far as I thought I could. So glad I recorded them. The downside to it is that, man, I look like I’ve gained 25 pounds and 15 years of age all of a sudden. I knew my overall health was declining due to the stress of this ordeal but geez…

So glad this is finally coming to the next phase – recovery.

Scheduled for “One of the more painful surgeries…”

I can’t believe I haven’t posted here since early May. I started, back in early April, keeping a private journal so I guess I just forgot about posting here. But, given what’s happened since my last post, and the lack of personal accounts for the type of surgery I’ll be getting, I will post often so that anyone in my situation might find this helpful in the future.

My last post was mainly focused on getting back to yoga and exercising, soon after meeting with a local spine surgeon who shocked me by recommending I avoid surgery for now and just “get back to my life.” I was so surprised by this, given the urgency and recommendation for surgery the prior two surgeons discussed with me. After the initial shock wore off, I was relieved and decided to put this all behind me and move on.

…until about a week later, when I woke up one morning and went to lift my right arm and realized that I had lost about half of its strength! Very scared, and now not trusting any of the three surgeons I had consulted with at that point, I started googling frantically to determine who the absolute best cervical spine surgeons are and whether I could get an appointment with them asap. Turns out, it’s pretty darned difficult to find a good surgeon. Everyone either likes or dislikes their doctors. Usually that’s based on how nice they are and not how effective. And the “Top Doctors” lists you’ll find on the web are pretty suspect.

After a pretty exhaustive search, I came to find two names repeatedly came up. One, a surgeon in New York City that specializes exclusively in cervical spine surgeries, and the other, a local surgeon at Jefferson who I already had the appointment with for late June. I called the NYC surgeon’s office and was told that he didn’t just take people via appointment, that I would need to submit all of my images and paperwork via a “study” portal, and it would be reviewed by he and his team and they would then decide if I was a candidate for surgery. If so, I’d get a call for an in-person office visit. I did, and it took longer than it should have, but I eventually got an appointment for a couple of months later, in June. It was the week I was on vacation at the beach but I couldn’t pass up on the opportunity, so that morning I set out for the 2.5 hour drive to midtown Manhattan, which was surprisingly not as difficult a drive as I expected, maybe because I expected it to be horrible…

Long story short, surgery, soon, was recommended. He said either he or the guy at Jefferson I was scheduled to meet the following week would be good – that Jefferson is a top-notch hospital for spine surgery and the doctor I had the appointment with was the best there. His recommendation if he does the surgery:

Anterior (front) Cervical Discectomy and Fusion (ACDF): C5 through C7, then flip me over and perform a C3 laminectomy*, C4 and C5 laminoplasty, and then, since I’d already be cut open posteriorly, he would add rods and screws to reinforce the C5 through C7 fusions. He warned me that it would be very painful for the first two weeks post-surgery, but that the benefits of this approach over a four level front and back fusion would be:

This all sounded both horrific (due to the pain) yet also wonderful, due to no loss in mobility. This surgeon has performed over 6000 cervical spine surgeries, has not had an infection since 2004, and I have since mentioned his name to a couple of other surgeons and they both agree he is top-notch. I scheduled the surgery for August 9th in New York, with the caveat that I may cancel pending the recommendation from the Jefferson surgeon.

A week later, I finally got in to see that final surgeon for a consult. He shocked me, yet again, by asking for a new MRI. I got the MRI and will finally, tomorrow, follow up with him for a final recommendation and decision. I’m expecting him to just tell me to go to NY and get the scheduled surgery, but at this point I give up on expecting anything as every step of the way I’ve been thrown curve balls.

So, exactly 25 hours from now, I’ll be getting the final input from him and then making my decision.

Regarding my right arm strength – it feels like it mostly has returned. I have been consistently attending yoga classes twice per week with no problem, and all pain is gone. Numbness is still there and has increased, and the last month or so I am also having some soreness/stiffness in my neck, which I never had before. All signs screaming out to me that I need to get this surgery soon. In the meantime, I’ll continue to do exercise consistently for as long as I can.

Stay tuned…

* the surgeon didn’t mention a laminectomy at all, focusing soley on the laminoplasty and fusion. However, after getting home and reviewing the visit report, it shows a laminectomy at C3. I emailed the nurse to get a clarification, along with asking her how painful/inadvisable a ~2.5 hour drive home soon after cervical spine surgery is : (

Diagnosed with Cervical Myelopathy

Spinal cord compressions

The last three months have been pretty devastating. The best way to describe it – this morning I had some downtime from work so I took an hour to go through and update this blog’s theme and do some maintenance. I noticed I had some draft post topics queued up, with titles like these:

All optimistic, inspirational. A few months ago, while playing pickleball, I felt soreness in my upper back and shoulder. After a week of it not getting better I self-diagnosed it as the pesky pinched nerve in my neck that had reared its ugly head every year or so for the past two decades of my life. It always went away after two weeks or so. But not this time – it stuck around. At about the third week mark, it was recommended I try this local chiropractor that has a glowing reputation. I have always been anti-chiropractor, accupuncture, voodoo, etc. Against my better judgment, I thought to myself, “Can’t really hurt. I’ll go for a couple of weeks and, if nothing else, get some free stretching out of it.”

Big mistake. While at first the guy seemed like he might know what he’s doing, in the end he either made things worse, or at the very least I dodged a major bullet in that he only manipulated my neck a couple of times… After multiple visits spanning a three or four weeks with him, my arm started getting painful to the point where, at the end of my second to last schedule appointment with him, he said if it’s not improved by next week he would refer me to a sports medicine doctor. I immediately canceled the last appointment with him and scheduled one with the sports medicine doctor myself. Something was wrong, and I knew it.

The sports med doc put me on prednisone tablets. Those didn’t work. And the pain in my arm increased. She then recommended an epidural steroid injection, but this required an MRI. My claustrophobia forced me to find an “open, upright” MRI place in the middle of nowhere in New Jersey. A couple of days later the sports med doctor called.

“Your MRI is showing severe issues that will require immediate surgery. I don’t know how you’ve been able to work all this time. Do you have short-term disability benefit through work? Get your ducks in a row and get that started first thing tomorrow while I get you an appointment with a surgeon asap.”

Sports Medicine Doctor

I was devastated. She was light on details of exactly what was wrong. Or maybe she did say it and I was in such shock that I didn’t process what she was saying.

Two days later I was in a spine surgeon’s examination room at Penn. Before the exam, the nurse had me walk down the hallway to get a quick set of x-rays. I distinctly recall walking down that hall and noticing one of the health professionals look up from her computer monitor and look at me with what I interpreted as a strange sense of confusion. But I didn’t pay any mind at the time.

A few minutes later I’m back in the exam room. The confused lady, who turned out to be the Physician’s Assistant to the spine surgeon, comes in. She performs some physical tests and then gets to the point and doesn’t mince words: my spine is compressed, I am at risk for paralysis, and the surgeon would be in shortly.

The surgeon comes in and we spend the next hour plus discussing the situation. Thankfully my wife was there with me to listen, ask questions, and take notes.

I’ll write more about this in a later post, but the diagnosis:

The first two do not necessitate surgery by themselves, so long as the pain is tolerable. The third is a major concern. At that time, surgery was not an option, but I had “months, not years” to get it done.

The surgeon said I am very unique in that my MRI shows someone who should be in much worse physical shape, showing much worse symptoms. Then they saw me and they were surprised. I have minor symptoms that are only found via testing, specifically, hyperreflexia and minor balance issue. But due to the pain from the radiculopathy, it’s best to just do the surgery and get this taken care of. He recommended a “hybrid” fusion plus disc replacement surgery that, I later found, is quite uncommon and two subsequent surgeons assessed as either “unheard of” or “neither I nor any of my colleagues would EVER do that.”

At the time, I had complete confidence in this surgeon. And, probably against better judgment, still have a good amount of confidence in him. That didn’t stop me from getting two additional opinions, and I’m also waiting to get two more.

After leaving the initial consult, things were steady for a few days. Then, all of a sudden, I woke up one evening with severe arm pain. So bad that I couldn’t sleep. The nerve pain radiating down my arm was extreme.

More to come. This needs a part two, obviously.